Elsevier

Sleep Medicine

Volume 14, Issue 8, August 2013, Pages 744-748
Sleep Medicine

Original Article
Delayed emergence of a parkinsonian disorder or dementia in 81% of older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder: a 16-year update on a previously reported series

https://doi.org/10.1016/j.sleep.2012.10.009Get rights and content

Abstract

Objective

To provide a 16-year update from the authors’ 1996 report documenting a 38% conversion from idiopathic rapid eye movement sleep behavior disorder (iRBD) to a parkinsonian disorder at a mean interval of nearly 13 years after the onset of iRBD in a series of 29 males ⩾50 years old.

Methods

The methods of evaluation, diagnosis and follow-up were previously described in the 1996 report. All patients had video-polysomnography (vPSG) confirmed RBD.

Results

80.8% (21/26) of patients who were initially diagnosed with iRBD eventually developed parkinsonism/dementia (three of the original 29 patients were lost to follow-up). The distribution of diagnoses was as follows: n = 13, Parkinson’s disease (PD); n = 3, dementia with Lewy bodies (DLB); n = 1, dementia (unspecified; profound); n = 2, multiple system atrophy (MSA); n = 2, clinically diagnosed Alzheimer’s Disease (AD) with autopsy-confirmed combined AD plus Lewy body disease pathology. Among the 21 iRBD “converters,” the mean age (±SD) of iRBD onset was 57.7 ± 7.7 years; mean age (±SD) of parkinsonism/dementia onset was 71.9 ± 6.6 years; and mean interval (±SD) from iRBD onset to parkinsonism/dementia onset was 14.2 ± 6.2 years (range: 5–29 years).

Conclusion

The vast majority of men ⩾50 years old initially diagnosed with iRBD in this study eventually developed a parkinsonian disorder/dementia, often after a prolonged interval from onset of iRBD, with the mean interval being 14 years while the range extended to 29 years. Also, the specificity of iRBD converting to parkinsonism/dementia is striking. These findings carry important clinical and research implications in the convergent fields of sleep medicine, neurology, and neuroscience, and identify an optimal clinical group for conducting prospective research studies utilizing putative neuroprotective agents to delay the emergence of, or halt the progression to, parkinsonism and/or cognitive impairment as manifestations of either PD, DLB or MSA.

Introduction

In 1996, we reported that 38% of a series of 29 males ⩾50 years old developed a parkinsonian disorder (all presumably with Parkinson’s disease [PD]) at a mean interval of nearly 13 years after the onset of idiopathic rapid eye movement sleep behavior disorder (iRBD) [1]. In that report, 16 patients with persistent iRBD were last evaluated on average six years from the time of their RBD diagnosis. We now provide a 16 year update from our 1996 report, with the primary focus of this report being the percent of iRBD patients who eventually developed parkinsonism/dementia, the interval from onset of iRBD to onset of parkinsonism/dementia, and the post-mortem neuropathological findings in two cases.

Section snippets

Methods

The methods of evaluation and follow-up have previously been described [1]. All patients had video-polysomnography (vPSG) confirmed RBD. Three patients (n = 1 with PD; n = 2 with dementia with Lewy bodies [DLB]), were subsequently referred to the Mayo Clinic to be managed by one of the authors (BFB) after their neurological disorders had emerged. One patient was lost to follow-up, but his wife was eventually contacted, and she provided information about her husband’s dementia, and clinical

Results

80.8% (21/26) of patients initially diagnosed with iRBD eventually developed parkinsonism/dementia. Table 1 contains the list of parkinsonism/dementia diagnoses, and the Fig. 1 provides a distribution of time intervals for conversion from iRBD to parkinsonism/dementia. The two patients with MSA had autonomic failure/urinary dysfunction with parkinsonism. One of these patients had persistent hypotension despite vigorous therapy with pressor agents, with his sitting BP commonly being 100/50, and

Discussion

The main findings from this study of men ⩾50 years, initially diagnosed with iRBD at the Minnesota Regional Sleep Disorders Center, is that the vast majority (80.8%) eventually developed a parkinsonian disorder/dementia, and often with a prolonged interval from onset of RBD to delayed emergence of parkinsonism/dementia, with the mean interval being 14 years and the range extending to 29 years. Also, the specificity of the RBD-parkinsonism/dementia association is striking, as only one patient from

Conflict of Interest

The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2012.10.009.

. ICMJE Form for Disclosure of Potential Conflicts of Interest Form.

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